Literature Review On Health And Safety At Work - Specialist's opinion

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Independent Review of Occupational Health and Safety Compliance and Enforcement in Victoria Report November Many scientific studies have revealed a trend towards an earlier onset of puberty and have disclosed an increasing number of children that display precocious puberty. Introduction. The Correctional Service of Canada (CSC) is responsible for providing a safe and secure environment in which offenders can work towards becoming law.

To systematically review evidence on the effect of health information technology on quality, efficiency, and costs of health care. We also added studies identified by experts up to April Two reviewers independently extracted information on system capabilities, design, effects on quality, system acquisition, implementation context, and costs. Most studies addressed decision support systems or electronic health records.

Three major benefits on quality were demonstrated: The primary domain of improvement was preventive health. The major efficiency benefit shown was decreased utilization of care. Data on another efficiency measure, time utilization, were mixed.

Empirical cost data were limited. Available quantitative research was limited and was done by a small number of institutions. Systems were heterogeneous and sometimes incompletely described. Available financial and contextual data were limited.

A Literature Review of Safety Culture the current endeavor was to conduct a review of the safety culture literature in order HSS Office of Health, Safety and. Literature Review On The Workplace If there is lack of proper health and safety measures then As according to the literature review the work environment is. Health Training A Literature Review Prepared by: Occupational safety and health training remains a fundamental work that offered the most positive evidence. Literature Review: Road Safety Work Group Background: Preventing injuries from road traffic collisions is simultaneously one of the greatest public health.

Four benchmark institutions have demonstrated the efficacy of health information technologies in improving quality and efficiency. Whether and how other institutions can achieve similar benefits, and at what costs, are unclear. Health Information Technology Frameworks. Search flow for health information technology HIT literature. All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP.

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Unauthorized use of the In the Clinic slide sets will constitute copyright infringement. Healthcare Delivery and Policy. Sign In Set Up Account. You will be directed to acponline. Open Athens Shibboleth Log In. Subscribe to Annals of Internal Medicine. Improving Patient Care is a special section within Annals supported in part by the U. Improving Patient Care 16 May Descriptive and comparative studies and systematic reviews of health information technology.

Much of the evidence on quality improvement relates learn more here primary and secondary preventive care.

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The major efficiency benefit has been decreased utilization of care. Effect on time utilization is mixed. Empirically measured cost data are limited and inconclusive. Most of the high-quality literature regarding multifunctional health information technology systems comes from 4 benchmark research institutions.

How much do we know about massage? A lot of the scientific research on massage therapy is preliminary or conflicting, but much of the evidence points toward beneficial effects on pain and other symptoms associated with a number of different conditions. Researchers have studied the effects of massage for many conditions. A review concluded that massage therapy may help temporarily reduce pain, fatigue, and other symptoms associated with fibromyalgia, but the evidence is not definitive. Massaging preterm infants using moderate pressure may improve weight gain, a review suggested. Massage therapy appears to have few risks when performed by a trained practitioner. In the United States, 44 states and the District of Columbia regulate massage therapists. Cities, counties, or other local governments also may regulate massage. Most states that regulate massage therapists require them to have a minimum of hours of training from an accredited training program. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners. The site includes questions and answers about clinical trials, guidance on how to find clinical trials through ClinicalTrials. The Cochrane Database of Systematic Reviews is a collection of evidence-based reviews produced by the Cochrane Library, an international nonprofit organization. The reviews summarize the results of clinical trials on health care interventions. NCCIH thanks the following people for their technical expertise and review of the content update of this publication: PDF files require a viewer such as the free Adobe Reader. Skip to main content. Safety Information Know the Science. Research Results Results by Date. Events Multimedia Video, Images, and Audio. Advisory Council Job Opportunities. Massage Therapy for Health Purposes Share:. Massage therapy dates back thousands of years. Sports massage combines techniques of Swedish massage and deep tissue massage to release chronic Literature Review On Health And Safety At Work tension. In some cases, pregnant women should avoid massage therapy. People with some conditions such as bleeding disorders or low blood platelet counts should avoid having forceful and deep tissue massage. People who take anticoagulants also known as blood thinners also should avoid them. Toll-free in the U. TTY for deaf and hard-of-hearing callers: Cochrane Database of Systematic Reviews The Cochrane Database of Systematic Reviews is a collection of evidence-based reviews produced by the Cochrane Library, an international nonprofit organization. Massage for promoting mental and physical health in typically developing infants under the age of six months. Cochrane Database of Systematic Review. Bureau of Labor Statistics. Bureau of Labor Statistics Web site. A comparison of the effects of 2 types of massage and usual care on chronic low back pain: Annals of Internal Medicine. Safety and efficacy of massage therapy for patients with cancer. Massage for low-back pain. Cochrane Database of Systematic Reviews. Massage therapy for fibromyalgia symptoms. Massage therapy for children with autism spectrum disorders: Journal of Clinical Psychiatry. Massage therapy for osteoarthritis of the knee: Effectiveness of therapeutic massage for generalized anxiety disorder: Complementary and alternative medicine use among adults and children: Diagnosis and treatment of low back pain: Dennis CL, Dowswell T. Interventions other than pharmacological, psychosocial or psychological for treating antenatal depression. Moderate pressure is essential for massage therapy effects. International Journal of Neuroscience. Yoga and massage therapy reduce prenatal depression and prematurity. Journal of Bodywork and Movement Therapies. Massage as an orthodox medical treatment past and future. The Gale Encyclopedia of Alternative Medicine. Harris M, Richards KC. The physiological and psychological effects of slow-stroke back massage and hand massage on relaxation in older people. Journal of Clinical Nursing. Treatment effects of massage therapy in depressed people: Massage therapy as a supportive care intervention for children with cancer. Pain management for women in labour: Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: Changes in clinical parameters in patients with tension-type headache following massage therapy: Physiological adjustments to click here measures following massage therapy: Evidence-Based Complementary Literature Review On Health And Safety At Work Alternative Medicine. Evidence-based evaluation of complementary health approaches for pain management in the United States. Schwartz More info, Monterastelli C. Randomized trial of therapeutic massage for chronic neck pain. Clinical Journal of Pain. Complementary and alternative medicine in the treatment of pain in fibromyalgia: Journal of Manipulative and Physiological Therapeutics. An overview of systematic reviews of complementary and alternative medicine for fibromyalgia. Massage for symptom relief in patients with cancer: Journal of Advanced Nursing. Acknowledgments NCCIH thanks the following people for their technical expertise and review of the content update of this publication: This publication is not copyrighted and is in the public domain. NCCIH has provided this material for your information. It is not intended to substitute for the medical expertise and advice of your primary health care provider. We encourage you to discuss any decisions about treatment or care with your health care provider.

Unauthorized use of the In the Clinic slide sets will constitute copyright infringement. Healthcare Delivery and Policy. Sign In Set Up Account. You will be directed to acponline. Open Athens Shibboleth Log In. Subscribe to Annals of Internal Medicine. Improving Patient Care is a special section within Annals supported in part by the U. Improving Patient Care 16 May Descriptive and comparative studies and systematic reviews of health information technology. Health information technology has been shown to improve quality by increasing adherence to guidelines, enhancing disease surveillance, and decreasing medication errors. Much of the evidence on quality improvement relates to primary and secondary preventive care. The major efficiency benefit has been decreased utilization of care. Effect on time utilization is mixed. Empirically measured cost data are limited and inconclusive. Most of the high-quality literature regarding multifunctional health information technology systems comes from 4 benchmark research institutions. Little evidence is available on the effect of multifunctional commercially developed systems. Little evidence is available on interoperability and consumer health information technology. A major limitation of the literature is its generalizability. Health care experts, policymakers, payers, and consumers consider health information technologies, such as electronic health records and computerized provider order entry, to be critical to transforming the health care industry Information management is fundamental to health care delivery 8. Given the fragmented nature of health care, the large volume of transactions in the system, the need to integrate new scientific evidence into practice, and other complex information management activities, the limitations of paper-based information management are intuitively apparent. While the benefits of health information technology are clear in theory, adapting new information systems to health care has proven difficult and rates of use have been limited Most information technology applications have centered on administrative and financial transactions rather than on delivering clinical care The Agency for Healthcare Research and Quality asked us to systematically review evidence on the costs and benefits associated with use of health information technology and to identify gaps in the literature in order to provide organizations, policymakers, clinicians, and consumers an understanding of the effect of health information technology on clinical care see evidence report at www. From among the many possible benefits and costs of implementing health information technology, we focus here on 3 important domains: We used expert opinion and literature review to develop analytic frameworks Table that describe the components involved with implementing health information technology, types of health information technology systems, and the functional capabilities of a comprehensive health information technology system We modified a framework for clinical benefits from the Institute of Medicine's 6 aims for care 2 and developed a framework for costs using expert consensus that included measures such as initial costs, ongoing operational and maintenance costs, fraction of health information technology penetration, and productivity gains. Financial benefits were divided into monetized benefits that is, benefits expressed in dollar terms and nonmonetized benefits that is, benefits that could not be directly expressed in dollar terms but could be assigned dollar values. See the full list of search terms and sequence of queries in the full evidence report at www. We also searched the Cochrane Central Register of Controlled Trials, the Cochrane Database of Abstracts of Reviews of Effects, and the Periodical Abstracts Database; hand-searched personal libraries kept by content experts and project staff; and mined bibliographies of articles and systematic reviews for citations. We asked content experts to identify unpublished literature. Finally, we asked content experts and peer reviewers to identify newly published articles up to April Two reviewers independently selected for detailed review the following types of articles that addressed the workings or implementation of a health technology system: We further categorized hypothesis-testing studies for example, randomized and nonrandomized, controlled trials, controlled before-and-after studies according to whether a concurrent comparison group was used. Hypothesis-testing studies without a concurrent comparison group included those using simple pre—post, time-series, and historical control designs. Remaining hypothesis-testing studies were classified as cross-sectional designs and other. These studies typically used hybrid methods—frequently mixing primary data collection with secondary data collection plus expert opinion and assumptions—to make quantitative estimates for data that had otherwise not been empirically measured. Cost-effectiveness and cost-benefit studies generally fell into this group. Two reviewers independently appraised and extracted details of selected articles using standardized abstraction forms and resolved discrepancies by consensus. We then used narrative synthesis methods to integrate findings into descriptive summaries. We grouped syntheses by institution and by whether the systems were commercially or internally developed. The funding sources had no role in the design, analysis, or interpretation of the study or in the decision to submit the manuscript for publication. Of articles, we rejected during initial screening: Of the remaining articles, we excluded descriptive reports that did not examine barriers Figure. We recorded details of and summarized each of the articles that we did include in an interactive database healthit. Twenty-four percent of all studies came from the following 4 benchmark institutions: The reports addressed the following types of primary systems: Of the hypothesis-testing studies, 84 contained some data on costs. Several studies assessed interventions with limited functionality, such as stand-alone decision support systems Such studies provide limited information about issues that today's decision makers face when selecting and implementing health information technology. Thus, we preferentially highlight in the following paragraphs studies that were conducted in the United States, that had empirically measured data on multifunctional systems, and that included health information and data storage in the form of electronic documentation or order-entry capabilities. Predictive analyses were excluded. Seventy-six studies met these criteria: The health information technology systems evaluated by the benchmark leaders shared many characteristics. All the systems were multifunctional and included decision support, all were internally developed by research experts at the respective academic institutions, and all had capabilities added incrementally over several years. Furthermore, most reported studies of these systems used research designs with high internal validity for example, randomized, controlled trials. Appendix Table 1 provides a structured summary of each study from the 4 benchmark institutions. This table also includes studies that met inclusion criteria not highlighted in this synthesis 26, 27, 30, 39, 40, 53, 62, 65, 70, The data supported 5 primary themes 3 directly related to quality and 2 addressing efficiency. Implementation of a multifunctional health information technology system had the following effects: The major effect of health information technology on quality of care was its role in increasing adherence to guideline- or protocol-based care. Decision support, usually in the form of computerized reminders, was a component of all adherence studies. The decision support functions were usually embedded in electronic health records or computerized provider order-entry systems. Electronic health records systems were more frequently examined in the outpatient setting; provider order-entry systems were more often assessed in the inpatient setting. Improvements in processes of care delivery ranged from absolute increases of 5 to 66 percentage points, with most increases clustering in the range of 12 to 20 percentage points. Twelve of the 20 adherence studies examined the effects of health information technology on enhancing preventive health care delivery 18, , 29, , 35, Eight studies included measures for primary preventive care 18, , 31, 33 , 4 studies included secondary preventive measures 29, 33, 35, 37 , and 1 study assessed screening not mutually exclusive The most common primary preventive measures examined were rates of influenza vaccination improvement, 12 to 18 percentage points , pneumococcal vaccinations improvement, 20 to 33 percentage points , and fecal occult blood testing improvement, 12 to 33 percentage points 18, 22, Three studies examined the effect of health information technology on secondary preventive care for complications related to hospitalization. One clinical controlled trial that used computerized surveillance and identification of high-risk patients plus alerts to physicians demonstrated a 3. One time-series study showed a 5—percentage point absolute decrease in prevention of pressure ulcers in hospitalized patients 35 , and another showed a 0. While most evidence for health information technology—related quality improvement through enhanced adherence to guidelines focused on preventive care, other studies covered a diverse range for types of care, including hypertension treatment 34 , laboratory testing for hospitalized patients, and use of advance directives see Appendix Table 1 for the numeric effects The second theme showed the capacity of health information technology to improve quality of care through clinical monitoring based on large-scale screening and aggregation of data. These studies demonstrated how health information technology can support new ways of delivering care that are not feasible with paper-based information management. Adverse drug events were associated with an absolute increase in crude mortality of 2. Two studies from Evans and colleagues 44, 45 reported using an electronic health record to identify adverse drug events, examine their cause, and develop programs to decrease their frequency. In the first study, the researchers designed interventions on the basis of electronic health record surveillance that increased absolute adverse drug event identification by 2. The report did not describe details of the interventions used to reduce adverse drug events. Three studies from the Veterans Affairs system examined the surveillance and data aggregation capacity of health information technology systems for facilitating quality-of-care measurement. Automated quality measurement was found to be less labor intensive, but 2 of the studies found important methodologic limitations that affected the validity of automated quality measurement. For example, 1 study found high rates of false-positive results with use of automated quality measurement and indicated that such approaches may yield biased results The second study found that automated queries from computerized disease registries underestimated completion of quality-of-care processes when compared with manual chart abstraction of electronic health records and paper chart sources Finally, 2 studies examined the role of health information technology surveillance systems in identifying infectious disease outbreaks. The first study found that use of a county-based electronic system for reporting results led to a 29—percentage point absolute increase in cases of shigellosis identified during an outbreak and a 2. The third health information technology—mediated effect on quality was a reduction in medication errors. Two studies of computerized provider order entry from LDS Hospital 51, 52 showed statistically significant decreases in adverse drug events, and a third study by Bates and colleagues 49 showed a non—statistically significant trend toward decreased drug events and a large decrease in medication errors. The first LDS Hospital study used a cohort with historical control design to evaluate the effect of computerized alerts on antibiotic use The second study from LDS Hospital demonstrated a 0. Although this outcome did not reach statistical significance, adverse drug events were not the main focus of the evaluation. The primary end point for this study was a surrogate end point for adverse drug events: The results from this trial were further supported by a second, follow-up study by the same researchers examining the long-term effect of the implemented system After the first published study, the research team analyzed adverse drug events not prevented by computerized provider order entry, and the level of decision support was increased. Health information technology systems also decreased medication errors by improving medication dosing. Studies examined 2 primary types of technology-related effects on efficiency: Eleven studies examined the effect of health information technology systems on utilization of care. Eight showed decreased rates of health services utilization ; computerized provider order-entry systems that provided decision support at the point of care were the primary interventions leading to decreased utilization. Types of decision support included automated calculation of pretest probability for diagnostic tests, display of previous test results, display of laboratory test costs, and computerized reminders. Absolute decreases in utilization rates ranged from 8. The primary services affected were laboratory and radiology testing. Most studies did not judge the appropriateness of the decrease in service utilization but instead reported the effect of health information technology on the level of utilization. Most studies did not directly measure cost savings. Instead, researchers translated nonmonetized decreases in services into monetized estimates through the average cost of the examined service at that institution. One large study from Tierney and colleagues examined direct total costs per admission as its main end point and found a The effect of health information technology on provider time was mixed. Two studies from the Regenstrief Institute examining inpatient order entry showed increases in physician time related to computer use 57, Another study on outpatient use of electronic health records from Partners Health Care showed a clinically negligible increase in clinic visit time of 0. Studies suggested that time requirements decreased as physicians grew used to the systems, but formal long-term evaluations were not available. Two studies showed slight decreases in documentation-related nursing time 68, 69 that were due to the streamlining of workflow. Data on costs were more limited than the evidence on quality and efficiency. Sixteen of the 54 studies contained some data on costs 20, 28, 31, 36, 43, 47, , , 63, Most of the cost data available from the institutional leaders were related to changes in utilization of services due to health information technology. Only 3 studies had cost data on aspects of system implementation or maintenance. Two studies provided computer storage costs; these were more than 20 years old, however, and therefore were of limited relevance 28, Massage therapy for children with autism spectrum disorders: Journal of Clinical Psychiatry. Massage therapy for osteoarthritis of the knee: Effectiveness of therapeutic massage for generalized anxiety disorder: Complementary and alternative medicine use among adults and children: Diagnosis and treatment of low back pain: Dennis CL, Dowswell T. Interventions other than pharmacological, psychosocial or psychological for treating antenatal depression. Moderate pressure is essential for massage therapy effects. International Journal of Neuroscience. Yoga and massage therapy reduce prenatal depression and prematurity. Journal of Bodywork and Movement Therapies. Massage as an orthodox medical treatment past and future. The Gale Encyclopedia of Alternative Medicine. Harris M, Richards KC. The physiological and psychological effects of slow-stroke back massage and hand massage on relaxation in older people. Journal of Clinical Nursing. Treatment effects of massage therapy in depressed people: Massage therapy as a supportive care intervention for children with cancer. Pain management for women in labour: Massage therapy versus simple touch to improve pain and mood in patients with advanced cancer: Changes in clinical parameters in patients with tension-type headache following massage therapy: Physiological adjustments to stress measures following massage therapy: Evidence-Based Complementary and Alternative Medicine. Evidence-based evaluation of complementary health approaches for pain management in the United States. Malingering, according to the DSM-IV-TR , refers to "the intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives" p. In the case of incarcerated populations, inmates may feign a suicide attempt via a self-inflicted superficial wound when internal motivations are not present. Thus, NSSI is considered to be malingering when it is motivated by external, rather than internal, motivations and a true suicidal intent is not present. Both malingering and self-mutilation lack suicidal intent, but self-mutilation is undertaken due to internal motivations e. In incarcerated populations, it may be a desire for self-preservation, the very opposite of suicidal intent, that motivates NSSI. If individuals are engaging in NSSI for this reason they are likely to be low-risk for suicide. Coid, Wilkins, Coid, and Everitt conducted the only study that has attempted to quantitatively derive a classification system for SIB in female inmates. While the uniqueness of this study makes it important, there are some limitations that must be considered. For example, the data were comprised of retrospective self-reports, the instruments used were not validated, the authors do not differentiate between NSSI and suicide attempts, and the number of participants is relatively small. The authors conducted a cluster analysis on 25 variables in a study of 74 female inmates who engaged in self-injury to derive two distinct groups. Emotions experienced prior to the behaviour included various combinations of anxiety, tension, anger, depression, irritability, and emptiness which may reach a point of depersonalization or derealization. For individuals in this cluster, the primary reason for engagement in SIB was to alleviate these emotions. Individuals in Cluster II , although highly heterogeneous, did tend to be older at first episode, had few or no previous episodes and some had inflicted injuries that were severe enough to be life-threatening. While this study suggests that different groups of SIB participants exist in incarcerated populations, further research is required to determine the nature of these groups. Fillmore and Dell published a study examining self-harm among Canadian women in federal prison in the Prairie region. The study used the following broad definition of self-harm: Data for this study were multi-sourced and entirely qualitative. The women in the study reported that self-harm is often used as a coping mechanism and serves the following functions: There was considerable overlap between what the offenders reported as reasons for self-harm and what the staff perceived to be the reasons for self-harm, with a few exceptions. Staff tended to minimize the importance of the need for attention, emphasised the need for women to influence others in order to take control of their situations, and placed much less emphasis on the motivation of dealing with isolation. The staff excluded the use of self-harm as an expression of painful experiences, but included self-harm as a form of manipulation. Both the inmates and the staff identified the family of origin i. This study provides some important exploratory data that will inform further research. However, the broad definition of self-harm and the qualitative nature of the data highlight a need for further quantitative research to augment these findings. Twenty-one percent of institutional service providers reported a perceived increase in women's self-harm in their women clients again used in a broad sense , although there is no verifiable data to back-up this claim and the time in which the increase occurred is not defined. There is evidence to support the existence of a distinct manipulative aspect to malingering in the context of incarcerated individuals. The existing literature reviewed in this section, in combination with theoretical differences for NSSI in incarcerated populations, suggest that classification for NSSI within incarcerated populations must be modified from those used to classify the general population. It is difficult to ascertain an accurate prevalence rate for NSSI , particularly in correctional institutions, for a number of reasons. First, this type of data is largely collected via self-report and the feelings of shame associated with NSSI due to its social unacceptability may lead to underreporting. Second, inconsistencies in defining NSSI lead to potential overestimations when definitions are too broad or underestimations when definitions are too constrained. Fourth, when articles concerning NSSI are published, they appear in a variety of speciality journals from cosmetic surgery to criminology, thus making it difficult to locate all the relevant literature Feldman, Studies may use the average number of occupied beds, the number of admissions to the facilities, the average daily population, or the average length of stay to calculate prevalence rates, resulting in disparate estimates. The most reliable study estimating the prevalence in the general adult population was conducted by Briere and Gil Four percent of the sample reported occasionally engaging in self-injury, and only 0. The prevalence of NSSI in community samples of adolescents and young adults is higher than among adults. In addition to the general difficulties with establishing prevalence rates outlined above, cultural differences may also be a factor given that the studies were conducted in several countries e. Prevalence rates among psychiatric populations are higher than among community samples. Prevalence rates in incarcerated populations. Incarcerated populations have an elevated risk for engaging in NSSI compared to the general population. Individuals who are incarcerated likely have an increased risk of NSSI prior to entering a correctional facility. While an increased likelihood of SIB in younger populations has been established, the influence of age on SIB within incarcerated populations is difficult to determine due to the general overrepresentation of younger individuals in correctional institutions Livingston, The existing literature suggests that incarcerated women may be as much as 5. Prevalence of types of NSSI. The prevalence of different types of SIB has yet to be clearly established; however, the vast majority of studies report that skin damage, particularly self-cutting, is the most common type of NSSI e. It is widely believed that women engage in NSSI more than men do, although the evidence is not definitive. While many studies do report a higher prevalence of NSSI among women and girls e. Cultural stereotypes may also play a role in the perception that males participate in NSSI less often because males can more easily lie about their scars or injuries attributing their injuries to work-related events, intoxication or physical conflict, but gender stereotypes provide women with few believable excuses for disfigurements Favazza, The types of NSSI that women engage in may differ from those chosen by men. There is some evidence that cutting, bruising, nail-biting, hair-pulling, and scratching are more common among females, while burning and hitting are more common among men, although these differences are not well-established Claes et al. Conventional wisdom suggests that males are more likely to use more violent means of SIB than females Hawton, If a higher level of severity does exist in males, it may be due to their greater suicidal intent, decreased concern with disfigurement, increased aggression, or a higher level of knowledge regarding violence as a means of self-injury Hawton, While some studies have failed to find a higher rate among Caucasians Whitlock et al. Mental health symptoms and diagnoses are not uncommon in individuals who self-injure, but individuals who self-injure are a heterogeneous group that exhibit an array of psychological issues Klonsky et al. BPD is a complex mental health syndrome characterized by instability of interpersonal relationships, self-image, and affect, in addition to marked impulsivity American Psychiatric Association, ; Paris, A diagnosis of BPD is constituted by meeting at least five of the nine criteria outlined in the DSM-IV-TR , one of which is recurrent suicidal behaviour, gestures or threats, or self-mutilating behaviour. Among individuals in psychiatric hospitals who self-injure, those with BPD may have more severe psychiatric disturbances than those with other personality disorders Herpertz, Theory suggests that individuals who meet the diagnostic criteria for BPD may have poorer emotional regulation skills and higher levels of emotional reactivity that elevates the risk for NSSI Linehan, A correlation between self-injury and a history of childhood abuse has been found in a plethora of studies e. However, a recent meta-analysis found that the relationship between childhood sexual abuse and NSSI was modest and likely due to the fact that childhood sexual abuse and NSSI are correlated with the same risk factors e. The mechanism by which abuse may lead to NSSI is not well understood. Although two studies have examined the relationship more closely in children and adolescents, none have tried to understand this process in adults Prinstein et al. It is unclear whether individuals use NSSI as a method of coping with negative emotions associated with abuse, as a way of imitating the abuse inflicted upon them in the past the abusive behaviour becomes "normal" for the individual or whether the NSSI is the result of another factor or factors associated with the abuse experience. Many victims of early abuse have an increased sense of worthlessness and a decreased understanding of the need to take care of themselves, including basic needs for physical well-being Chu, The types of self-injury chosen by individuals with these histories may directly imitate abuse suffered previously and serve as a means to re-enact the original trauma Connors, Stemming from feelings of worthlessness, victims of childhood abuse often lack the ability to internally self-soothe, thus self-injury becomes an external method of self-soothing that is used to deal with the overwhelming negative emotions that result from the past trauma Gallop, Similar to the case of eating disorders, some authors consider substance abuse to be a form of self-harm. Research has not yet determined why substance abuse and NSSI are correlated. Posttraumatic Stress Disorder PTSD is a psychological disorder that includes a characteristic set of symptoms arising from exposure to an extremely traumatizing event American Psychiatric Association, Given the high rates of PTSD , history of abuse, and substance abuse in offender populations, it is likely that offenders are at increased risk for NSSI. An association between depression, anxiety and NSSI has been found in community and forensic studies Andover et al. Individuals who self-injure may manifest depression in qualitatively different ways than depressed individuals who do not self-injure. A study comparing patients receiving treatment for depression to individuals who engage in NSSI found no significant difference in the quantitative amount of depression as measured by the Beck Depression Inventory, but there were significant differences in the types of depressive symptoms reported Bennum, For instance, participants predominately female who were receiving treatment for depression were more likely to report symptoms of crying, sleep disturbance, fatigue, loss of appetite, somatic preoccupation and loss of libido, while the individuals who engaged in NSSI were more likely to endorse experiencing guilt, self-dislike, self-punishment, and body image problems. The link between eating disorders and NSSI is not surprising. Indeed, many definitions of self-harm would encompass the behaviours of individuals with anorexia or bulimia and some authors consider eating disorders to be a type of self-injury van der Kolk et al. Obsessive exercising and vomiting may be used as an avoidant coping strategy or to release negative emotions such as anger and tension in the same way that self-injury is used, both of which may put an individual's survival at risk Goodsitt, Poorer nonverbal problem-solving skills may contribute to use of aggression in difficult situations by these populations Chowenac at al. Studies have found a correlation between suicidality, NSSI and same-sex attraction that is significant in diverse samples and with varying measurements of same-sex attraction and homosexuality. Skegg, Nada-Raja, Dickson, Paul and Williams found that same-sex attraction not engaging in homosexual activity increased risk for self-injury in both men and women. Men with even low levels of same-sex attraction were still significantly more likely to report engaging in self-injury than those who did not report these attractions even when psychiatric morbidity was controlled. The differences between suicidal behaviours and NSSI have been established, despite some overlap in risk factors Muehlenkamp, ; Walsh, While NSSI and suicide attempts are distinct behaviours, there is a correlation between the two. It has been suggested that previous SIB is the single best predictor of eventual suicide Prinstein, NSSI has been found to be correlated with past suicide attempts and suicidal ideation in several studies Matsumoto et al. Brown, Comtois and Linehan found distinct differences in reported reasons for engaging in NSSI versus a suicide attempt. In their study, NSSI was associated with a desire to express anger, inflict punishment on oneself, induce normal feelings, and distract oneself from emotions, whereas suicide attempts were most frequently reported as intending to improve the lives of others i. However, overlap was found in one area: While individuals who self-injure are at elevated risk for attempting suicide, many of these individuals have never tried to kill themselves. A longitudinal study of 11, individuals presenting to a hospital for NSSI in England and Wales found that after one year, 0. While these rates are much higher than those of the general population 0. The same study, however, did find that individuals who had a history of multiple NSSI incidents were more likely to die by suicide than those who only had a single incident Hawton et al. In addition to the dearth of empirical research, the picture is further complicated by the fact that a single individual may engage in NSSI for a several reasons and his or her reasons for engaging in such behaviours may change over time Kleindienst et al. Yet the motivation for self-injury may be a critical factor for understanding the behaviour so that the individual can be successfully treated and his or her risk for the repeating the behaviour reduced. The following section reviews the theories of motivation for NSSI and the empirical evidence supporting the theory. Figure 2 presents a model of motivations for SIB , primarily based on the work of Suyemoto and Klonsky The environmental models are largely based on behavioural and developmental theories, emphasizing motivations for NSSI as being related to an individual's surroundings Suyemoto, The Reinforcement, Contagion, and Learned Behaviour models are all environmental models. This model suggests that individuals may self-injure to receive secondary rewards e. For instance, individuals will increase their NSSI due to the reinforcement they receive which can be the addition of a positive consequence e. The strongest evidence for this explanation comes from Brown et al. While interpersonal influence may be a factor, it is not usually the primary reason for engagement in the behaviour. These studies collectively provide some support for the reinforcement functions of NSSI , although the majority of the studies focus on adolescent populations and more empirical research is needed to strengthen the evidence. Reports of self-mutilation contagion have been occurring for nearly a century, with Holdin-Davis' description of an epidemic of trichotillomania in an orphanage being the first known report. This figure presents the models of the functions of NSSI , primarily based on the work of Suyemoto and Klonsky Individual models that fit within each category are also listed. Heney found that federally sentenced women and staff at the Prison for Women in Kingston, Ontario reported outbreaks of self-injury, although the explanation for these outbreaks was not in-line with the contagion effect. Many of the offenders and staff believed that "tension" or situational factors were largely to blame for outbreaks of NSSI. Thus, in most cases the women were not copying the behaviour of others, but women were experiencing the same stressors together, and thus their NSSI incidents coincided with this trigger. These outbreaks were not confirmed quantitatively. There is still some debate about the existence of the contagion effect as rigorous empirical evidence is limited and has not definitively demonstrated the existence of this phenomenon. However, it is possible that individuals are influenced by the behaviour of others even though they do not acknowledge the influence or are unaware the influence has even taken place. Social learning theory Bandura, is especially relevant in the learned behaviour model as it emphasizes vicarious reinforcement, self-reinforcement, family relationships, and modelling. This model proposes that NSSI behaviours were learned through the experience of individuals having injuries involuntarily inflicted upon them through past abuse, leading them to feel that the self-injury is "right" or deserved Himber, ; Suyemoto, This is distinct from reinforcement and contagion, as what is learned is that the experience of being abused is normative, not the specific behaviour. Drive models conceptualize NSSI as an expression or repression of life, death and sexual drives and are based on psychoanalytic developmental theory Suyemoto, Within the drive models are the antisuicide and the sexual models. The antisuicide explanation for NSSI is common throughout the literature e. In a sample of women diagnosed with BPD , the anti-suicidal function was rated seventh in a list of seventeen possible functions Shearer, Thus, while there is some evidence of the anti-suicidal motivation, it is modest Klonsky, The sexual model proposes that NSSI either reflects a positive relationship with sex e. Individuals may struggle with experiencing sexual feelings over which they perceive no control and may use self-injury as a way to fight back or gain the perception of control Cross, It may also be used as a way of purifying the body from the uncleanliness of sexual feelings or traumatic memories Hewitt, ; Himber, The majority of studies that support engagement in NSSI due to sexual motivations are case studies Daldin, ; Himber, ; Kafka, ; Siomopoulos, ; Woods, , theoretical papers Cross, ; Hewitt, or reports of observational and clinical data obtained in a psychiatric institution that were not systematically collected Friedman et al. Thus further study would be required to determine the validity of these claims. Many authors view affect regulation as the primary purpose of NSSI e. This explanation includes the coping model, which is concerned with the expression of, and relief from, intense emotions, and the dissociation model, which views NSSI as a way of ending uncomfortable feelings of dissociation. Thus, NSSI is implemented as a maladaptive coping strategy used to diminish troublesome thoughts and feelings Favazza, After systematically reviewing 18 studies that empirically investigated motivations for engaging in NSSI , Klonsky concluded the following:. There is additional support for the coping model in research on incarcerated populations. Dear, Thomson, Hall, and Howells compared 71 offenders 64 male and 7 female who engaged in SIB with matched controls and found that those who engaged in SIB were found to use significantly different coping strategies than those who did not. Those who engaged in SIB were less likely to use problem-solving or active cognitive coping strategies, which are thought to be more adaptive strategies, and rated their overall coping response as less effective compared to the control group. In a follow-up to this study, blind raters judged the coping strategies used by those who self-injure to be less appropriate for the situation they were dealing with Dear et al. The suggestion that NSSI is used as a form of self-inflicted punishment is commonly presented in the literature. In fact, in Klonsky's review article, all 11 self-report studies included self-punishment as an explanation, making it the most commonly attributed reason for self-injury after coping. Research suggests that females are more likely than males to engage in NSSI for reasons of self-punishment Claes et al. Self-injury in women may be viewed as a typically female expression of anger riddled with self-blame and a sense of responsibility for the harm that was done to them Motz, ; Shapiro, The dissociation model is also conceptualizes NSSI as a form of affect regulation, but dissociation is a very unique experience from other types of negative emotions. In particular, seeing blood facilitates the ending of the dissociative experience for some and thus may be specifically linked to cutting as the form of NSSI Simpson, ; van der Kolk et al. The empirical findings for the dissociation model are mixed Klonsky, Studies have found that individuals who self-injure are more likely to experience dissociation Gratz et al. The Boundaries and Communication models are included in this category. When faced with a situation of abandonment, individuals may feel anger at the person who is abandoning them as well as anger at themselves for their own neediness Woods, The anger that is simultaneously directed outward and inward can create a sense of confusion that is put to an end with NSSI. Beyond just relief from negative feelings, NSSI may actually induce a pleasurable state Himber, Physical pain may also be perceived to be more controllable and thus transferring the emotional pain to physical pain may make it seem less overwhelming Friedman et al. For some individuals, NSSI is a form of communication; a way of expressing how badly they feel, the type of harm that was done to them in the past, and their current need for help Himber, ; Liebling et al. While many individuals are secretive and ashamed of their NSSI , some want other people to witness what they have done to themselves as a form of communication Himber, ; Liebling et al. Individuals who experienced abusive and neglectful childhoods may find it particularly difficult to ask for help as their past experiences lead them to expect their requests to go unanswered. Consequently, the damage, such as wounds and scars, relay their need for help to others. While the phenomenon of NSSI is believed by some to be the same syndrome regardless of the location in which it takes place, institutionalized populations i. As discussed previously, incarcerated individuals are at increased risk for NSSI. Institutionalized populations have the unique experience of being surrounded by other individuals who are at increased risk for NSSI and other mental health issues while residing in an environment they have little control over. There is also some evidence that the prevalence of NSSI among offenders prior to their incarceration may be higher than that of community samples Jones, It is unclear whether incarceration causes NSSI or incarcerated individuals are more likely than non-incarcerated individuals to have a history of NSSI prior to entering the correctional system. Given that it is impossible to randomly assign individuals to a correctional institution, causal statements about the effects of institutionalization on NSSI cannot be made. The best approximation in this area would be multi-wave longitudinal studies which may allow the researchers to infer causality, but no such studies have been conducted. Maden, Chamberlain and Gunn suggest that the relationship between SIB and the correctional environment is too complex to be explained by a straightforward causal relationship. In their sample of 1, male prisoners, the authors found that SIB was related to neurotic and personality disorders and cannot simply be explained by environmental stress. The limited research, and the conflicting findings in the research that does exist, highlights an important gap in the literature: Information regarding whether individuals begin to self-injure before or after admission to an institution, and any changes in the behaviour that occur after admission, would provide key information regarding the effect of the correctional environment on such behaviours. Some offenders may use self-injury as a way of coping with negative feelings, and therefore use NSSI was a way to cope with the negative feelings of being incarcerated. Thus, the NSSI may not be a new behaviour or even a new way of using NSSI , but being incarcerated may simply provide another source of negative feelings that the individual must cope with. It is quite possible that those who are at an increased risk for institutionalization in prisons and psychiatric hospitals are also at an increased risk for NSSI i. Further evidence is required in order to understand the relationship between NSSI and institutionalization. Many theoretical models have been proposed to explain the motivations for NSSI. While more research is required to further elucidate the validity of some of these models, research does appear to support multiple pathways and multiple motivations for initiating and maintaining this behaviour. Thus far, only one published article has attempted to empirically validate pathways to self-harm and the sample within that study was limited to depressed women with a history of childhood sexual abuse Gladstone et al. It is most likely that those who engage in SIB are a heterogeneous group. An empirically derived typology could help organize this diversity into a system that can better inform risk assessment and treatment of these individuals. Despite the large number of academic articles that address SIB , further research is still needed in order to gain a complete and accurate understanding of this behaviour. The current literature lacks large-scale, empirical research that adequately assesses NSSI in incarcerated populations. Basic information such as the prevalence of the behaviour has yet to be well-established. Regardless of prevalence rate, skin cutting has been found to be the most common type of NSSI. Several attempts have been made to develop a classification system that would be useful for researchers and clinicians, but no adequate system has been developed and no one system is in widespread use. While research has yet to determine the process by which NSSI is initiated and maintained, several factors have been identified as being associated with NSSI. These correlates include borderline personality disorder, history of trauma and abuse, PTSD , depression, eating disorders, same-sex attraction and homosexuality, impulsivity, anger and aggression. Suicide has been found to be a correlate, but is a behaviour that is distinct from NSSI. This literature review was undertaken to determine what is currently known about SIB and what gaps exist in the literature in order to inform future research on SIB in CSC 's federal institutions. In light of the available research, CSC 's current approaches and policies concerning SIB will be examined and a well-grounded plan for future research will be established based on this analysis. The following section briefly reviews current policy that guides CSC 's response to self-injurious behaviour. Within the CSC , Commissioner's Directive outlines the official policy regarding the prevention, management and response to suicide and self-injuries within federal institutions CSC , According to this document, offenders who are self-injurious or suicidal cannot be punished for participating in SIB. However, offenders could be placed on "suicide watch", which involves isolating an inmate who is deemed to be of imminent danger for self-injury or suicide if the level of risk cannot be reduced to an acceptably low level by other means. While this isolation is implemented to insure the safety of the offender by providing greater opportunity for observation of his or her behaviour, it is often viewed as punishment by the individual who is engaging in the self-injury or others who are not fully aware of the case history. Staff members are permitted to use restraints in order to reduce the risk of self-injury CSC , Physical restraints are only implemented after less restrictive interventions, such as verbal interventions, are deemed to be ineffective and the individual is at risk of serious bodily harm to themselves. Like suicide watch, the use of restraints is often viewed as a punitive measure by the individual engaging in SIB and others who are not familiar with the case, despite the important role restraints play in ensuring the safety of the individual. The current priority at the CSC in responding to SIB is to decrease the severity of damage that an individual inflicts on him- or herself, and thus the offenders' negative perceptions of these kinds of interventions must be balanced with the priority of offender safety. CSC 's policy also details communications that must take place once an offender has revealed suicidal or self-injurious thoughts CSC , This communication process ensures that staff are notified of the offender's increased risk for SIB so that appropriate treatment and monitoring can be implemented. All staff who have regular interaction with offenders are required to take Suicide Awareness training CSC , which is designed to improve staff's ability to recognize and effectively deal with signs of SIB. The paper provides a summary of the literature on SIB. While many studies have been conducted, there are still important gaps in the literature that must be addressed. Current classification systems are insufficient, particularly for incarcerated populations, yet an empirically derived system could provide an important framework for treating and managing NSSI in correctional facilities. Reliable information on the prevalence of NSSI within the CSC 's facilities would allow for a more accurate understanding of the number and kind of resources required to address this issue, in addition to providing a benchmark that could be used to assess whether changes in rates of NSSI occur over time. It is likely that NSSI differs between men and women, and, possibly, between different ethnic groups. Further research on these differences could be used to create gender-informed and culturally sensitive strategies for treating and managing NSSI. Most importantly, there is no clear answer to the question of why individuals engage in NSSI and how this behaviour is initiated and maintained over time. The use of NSSI as a coping mechanism is likely to be an important motivator, but this single explanation is too simplistic to provide a comprehensive picture of NSSI in correctional facilities. In addition, the effect, if any, of institutionalization on NSSI needs to be elucidated. Increasing the understanding of the development and maintenance of NSSI is imperative for the development of appropriate strategies to address this behaviour, including efforts to reduce and ultimately prevent its occurrence. Two of CSC 's corporate priorities are: Suicide and SIB within CSC 's institutions pose a threat to the mental health and physical safety of offenders and staff alike.

Little evidence is available on the effect of multifunctional commercially developed systems. Little evidence is available on interoperability and consumer health information technology. A major limitation of the literature is its generalizability. Health care experts, policymakers, payers, and consumers consider health information technologies, such as electronic health records and computerized provider order entry, to be critical to transforming the health care industry Information management is fundamental to health care delivery 8.

Given the fragmented nature of health care, the large volume of transactions Literature Review On Health And Safety At Work the system, the need to integrate new scientific evidence into practice, and other complex information management activities, the limitations of paper-based information management are intuitively apparent. While the benefits of health information technology are clear in theory, adapting new information systems to health care has proven difficult and rates of use have been limited Most information technology applications have centered on administrative and financial transactions rather than on delivering clinical care The Agency for Healthcare Research and Quality asked us to systematically review evidence on the costs and benefits associated with use of health information technology and to identify gaps in the literature in order to provide organizations, policymakers, clinicians, and consumers an understanding of the effect of health information technology on clinical care this web page evidence report at www.

From among the many possible benefits and costs of implementing health information technology, we focus here on 3 important learn more here We used expert opinion and literature review to develop analytic frameworks Table that describe the components involved with implementing health information technology, types of health information technology systems, and the functional capabilities of a comprehensive health information technology system We modified a framework for clinical benefits from the Institute of Medicine's 6 aims for care 2 and developed a framework for costs using expert consensus that included measures such as initial costs, ongoing operational and maintenance costs, fraction of health information technology penetration, and productivity gains.

Financial benefits were divided into monetized benefits that is, benefits expressed in dollar terms and nonmonetized benefits that is, benefits that could not be directly expressed in dollar terms but could be assigned dollar values.

See the full list of search terms and sequence of queries in the full evidence report at www. We also searched the Cochrane Central Register of Controlled Trials, the Cochrane Database of Abstracts of Reviews of Effects, and the Periodical Abstracts Database; hand-searched personal libraries kept by content experts and project staff; and mined bibliographies of articles and systematic reviews for citations. We asked content experts to identify unpublished literature.

Finally, we asked content experts and peer reviewers to identify newly published articles up to April Two reviewers independently selected for detailed review the following types of articles that addressed the workings or implementation of a health technology system: We further categorized hypothesis-testing studies for example, randomized and nonrandomized, controlled trials, controlled before-and-after Literature Review On Health And Safety At Work according to whether a concurrent comparison group was used.

Hypothesis-testing studies without a concurrent comparison group included those using Literature Review On Health And Safety At Work pre—post, time-series, and historical control designs. Remaining hypothesis-testing studies were classified as cross-sectional designs and other. These studies typically used hybrid methods—frequently mixing primary data collection with secondary data collection plus expert opinion and assumptions—to make quantitative estimates for data that had otherwise not been empirically measured.

Cost-effectiveness and cost-benefit studies generally fell into this group. Two reviewers independently appraised and extracted details of selected articles using standardized abstraction forms and resolved discrepancies by consensus. We then used narrative synthesis methods to integrate findings into descriptive summaries.

We grouped syntheses by institution and by whether visit web page systems were commercially or internally developed. The funding sources had no role in the design, analysis, or interpretation of the study or in the decision to submit the manuscript for publication. Of articles, we rejected during initial screening: Of the remaining articles, we excluded descriptive reports that did not examine barriers Figure.

We recorded details of and summarized each of the articles that we did include in an interactive database healthit. Twenty-four percent of all studies came from the following 4 benchmark institutions: The reports addressed the following types of primary systems: Of the hypothesis-testing studies, 84 contained some data on costs. Several studies assessed interventions with limited functionality, such as stand-alone decision support systems Such studies provide limited information about issues that today's decision makers face when selecting and implementing health information technology.

Thus, we preferentially highlight in the following paragraphs studies that were conducted in the United States, that had empirically measured data on multifunctional systems, and that included health information and data storage in the form of electronic documentation or order-entry capabilities.

Predictive analyses were excluded.

Health and Safety Executive A literature review of the health and safety This report and the work it describes were funded by the Health and Safety Executive. European Agency for Safety and Health at Work. Emergency Services: A Literature Review on Occupational Safety and Health Risks. Wellbeing at work: creating a positive work environment. Authors. A report prepared for the European Agency for Safety and Health at Work, EU-OSHA, by the Topic. The business benefits of health and safety. A literature review June Edition 1 cocktail24.info ‘Leading occupational health and safety at work. Review of Literature on Health & Safety. Literature Review on Health & Safety To provide a framework for epidemiological research on work and health that.

All the systems were multifunctional and included decision support, all were internally developed by research experts at the respective academic institutions, and all had capabilities added incrementally over several years.

Furthermore, most reported studies of these systems used research designs with high internal validity for example, randomized, controlled trials. Appendix Table 1 provides a structured summary of each study from the 4 benchmark institutions. This table also includes studies that met inclusion criteria not highlighted in this synthesis 26, 27, 30, 39, 40, 53, 62, 65, 70, The data supported 5 primary themes 3 directly related to quality and 2 addressing efficiency.

Implementation of a multifunctional health information technology system had the following effects: The major effect of health information technology on quality of care was its role in increasing adherence to guideline- or protocol-based care. Decision support, usually in the form of computerized reminders, was a component of all adherence studies.

The decision support functions were usually embedded in electronic health records or computerized provider order-entry systems. Electronic health records systems were more frequently examined in the outpatient setting; provider order-entry systems were more often assessed in the inpatient setting.